Colour Doppler imaging in the demonstration of an orbital varix.

Colour Doppler imaging (CDI) is a recent development in ultrasonography. It allows simultaneous two-dimensional structural imaging and Doppler evaluation of blood flow. Quantitative information on flow velocity is obtained by pulsed Doppler spectral analysis, the colour information being used to choose the vessel of interest. Using this technique the authors examined a patient with an orbital varix previously diagnosed by clinical findings and computed tomography. Dynamic evaluation with real-time direct imaging of flow facilitated the diagnosis of this orbital disorder without the need for any contrast material. This technique may prove to be a useful adjunct to computed tomography for the evaluation of suspected vascular lesions of the orbit.     

Metastasis of choroidal melanoma to the contralateral choroid, orbit, and eyelid.

A 52-year-old woman was found to have a small juxtapapillary pigmented lesion in the choroid of the left eye. This lesion remained clinically stationary for one year, but subsequent growth prompted enucleation of the eye. The tumour was diagnosed histologically as a choroidal malignant melanoma of mixed cell type. Approximately 52 months later the patient developed proptosis of the contralateral (right) eye. Orbital ultrasonography showed a large mass in the right orbit, which was confirmed by needle biopsy to be a melanoma. In addition the patient was found to have metastatic melanoma to the choroid, right lower eyelid area, and liver. The development of simultaneous orbital, choroidal, and eyelid metastases from a contralateral choroidal melanoma is of ophthalmic interest and appears to be unique.     

Malignant melanoma associated with melanocytoma of the optic disc

A 61-year-old white man underwent enucleation because of progressive growth of a pigmented epipapillary tumor that was diagnosed 9 years earlier as an optic nerve and juxtapapillary melanocytoma. Histopathologic studies showed the tumor was a malignant melanoma of the optic disc and juxtapapillary retina and choroid. Foci of typical melanocytoma cells were within the tumor. The tumor produced segmental atrophy of the optic nerve. This is a rare example of a malignant melanoma developing in conjunction with a lesion that possessed typical clinical and histopathologic features of a melanocytoma of the optic disc.     

Epithelial downgrowth following the removal of iris inclusion cysts

We present three patients in whom epithelial downgrowth occurred following the excision of iris inclusion cysts. The sheet-like downgrowth was aggressively treated and successfully eradicated in two of the three patients. Early identification and prompt therapy are essential.     

Occult prostatic carcinoma metastatic to the medial canthal area. Diagnosis by immunohistochemistry

A 91-year-old man developed a mass in the right medial canthal and lacrimal sac region, which was found histopathologically to be a poorly differentiated neoplasm. The results of a complete systemic evaluation, including urologic consultation, rectal examination, bone scan, and determination of serum acid phosphatase level, were normal. In spite of the negative evaluation for prostatic carcinoma, immunohistochemical studies using immunoperoxidase stains for prostatic-specific antigen demonstrated that the lacrimal sac tumor was metastatic carcinoma from an occult primary neoplasm in the prostate gland. The presence of tumor in the prostate gland was then confirmed by a needle biopsy. Modern immunohistochemical techniques are particularly valuable in the diagnosis of selected ophthalmic tumors in which the diagnosis cannot be determined by routine diagnostic techniques.     

Recurrence of posterior uveal melanoma after 60Co episcleral plaque therapy

The authors analyzed the clinical and follow-up data on 277 selected patients with primary choroidal or ciliochoroidal melanoma who were treated with 60Co plaque radiotherapy between 1976 and 1982. Local recurrence of the irradiated melanoma developed in 39 (14%) patients during the follow-up interval. The 5-year tumor recurrence rate (Kaplan-Meier) was estimated to be 12%. Multivariate prognostic factor analysis (Cox proportional hazards modeling) identified the largest linear tumor dimension and proximity of the posterior margin of the tumor to the optic nerve head as predictors of recurrence. The 5-year survival rate of patients whose tumors recurred (58%) was significantly (log-rank test P = 0.0023) worse than that of patients whose tumor remained clinically controlled (82%).     

Use of a commercial reagent leads to reduced germ tube production by Candida dubliniensis

The goal of this study was to determine the factor(s) explaining our inability to detect Candida dubliniensis. When germ tube-positive yeasts were tested for C. dubliniensis, no C. dubliniensis was detected; however, 58 C. dubliniensis strains were detected when germ tube-negative Candida albicans strains were tested further. Since all 58 C. dubliniensis strains detected were germ tube negative, these data implied that false-negative germ tube tests occurred with germ tube solution (GTS; Remel, Lenexa, KS). All 41 known C. dubliniensis strains tested were negative with GTS, whereas 40 were positive with rabbit serum (RS; Sigma-Aldrich, St. Louis, MO). Results for C. albicans were equivalent in GTS and RS. In conclusion, GTS cannot be used for the detection of C. dubliniensis, and switching from yeast to hyphae in C. dubliniensis is more restricted than in C. albicans.     

Gamma-Ray Induction of Malignant Tumors in Rats

Sources of protracted gamma radiation adjacent to bone were found to induceosteogenic sarcoma in half of the exposed males. Osteogenic sarcomas appeared in 3 males remote from the radioactive sources and may not have been radiation induced. Some tumors were small enough so that the site of origin could be determined accurately: some arose from endosteum, others from periosteum. Although portions of the skeleton in the female rats incidentally received doses of over 20,000 rads, no osteogenic sarcomas developed in them. Parauterine sources induced adenocarcinoma of the endometrium in 14 of 32 rats (44%). The incidence of carcinoma of the ovary (12%) was lower than expected. Carcinomas of the breast were frequent, but often distant from the source. Increased total dose, which was usually related to length of time of exposure, produced an increased incidence of cancer and a shortening of the latent period. However, extremely high doses (over a million rads to bone and hundreds of thousands to the uterus) at times failed to induce cancers.     

Epstein-Barr-virus-transformed lymphoblastoid cell lines derived from patients with X-linked agammaglobulinaemia and Wiskott-Aldrich syndrome: responses to B cell growth and differentiation factors.

Epstein-Barr-virus-transformed B lymphoblastoid cell lines (EBV-transformed LCL) from three patients with X-linked agammaglobulinaemia (XLA), six patients with Wiskott-Aldrich Syndrome (WAS), and seven normal donors, were tested for growth and differentiation in response to human recombinant IL-4, a commercially available, low molecular weight B cell growth factor (BCGFlow), and B cell differentiation factor (BCDF) secreted by the T24 cell line, now known to be IL-6. Proliferation (3H-TdR uptake) by EBV-transformed LCL from both XLA and WAS patients in response to BCGFlow was similar to that obtained with the normal cell lines. In addition, three normal and three WAS, but none of the XLA EBV-transformed LCL, proliferated a little in response to IL-4. All the normal B cell lines secreted IgM, and six out of the seven secreted IgG in response to BCGFlow and BCDF. A similar pattern of response was obtained with the WAS EBV-transformed LCL (6/6 secreted IgM and 4/6 secreted IgG). Several of the normal and WAS EBV-transformed LCL also secreted IgM and IgG in response to IL-4. In contrast, the lines from the XLA patients were abnormal. One secreted large amounts of IgM and two secreted small amounts, but none of the XLA lines secreted IgG constitutively or in response to any of the factors (IL-4, BCDF). The lack of detectable IgG secretion by the XLA lines was probably due to an absence of precommitted IgG B cell precursors transformed by EBV rather than an intrinsic inability to respond to BCGF and BCDF. All of the lines, including those derived from XLA patients, were shown to secrete B cell growth and differentiation factors detected on indicator B cell lines. These results suggest that the abnormal X-linked genes responsible for XLA and WAS do not interfere with B cell responses to B cell growth and differentiation factors.